Study of Managed Care Population Suggests Inferior Vena Cava Filters May Be Overused

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"In addition, the low rates of filter removal indicate that patients may be at unnecessary risk of filter-induced DVT."

LOUISVILLE, Ky.--(BUSINESS WIRE)--Humana Inc. (NYSE: HUM) today announced research findings that suggest
inferior vena cava (IVC) filters may be overused in managed care
populations, and that filters may not always be removed after they are
no longer needed.

The study, published in theJournal
of Thrombosis and Thrombolysis, compared health outcomes between
patients who received IVC filters and patients who were potentially
eligible for filters but did not receive them.

IVC filters were developed for patients who are at risk of deep vein
thrombosis (DVT) (a thrombosis is a blood clot) but are unable to
receive anticoagulants for preventive treatment, either because they
aren’t effective for these patients or because of recent surgery or
other contraindications.

During the procedure, the filter is placed in the inferior vena cava
vein, the body’s largest vein, and serves to catch clots migrating from
other parts of the body before they can get to the heart or lungs and
potentially cause a life-threatening condition called a pulmonary
embolism (PE).

Though the filters are only recommended for patients who cannot use
anticoagulants, the study found that anticoagulant use was actually
greater in patients who had undergone filter placement than in patients
who had not received filters. This finding implies that IVC filters are
frequently used in cases that do not meet the criteria of clinical
practice guidelines.

This is a cause for concern, as the study also found that patients who
received filters experienced higher rates of subsequent hospitalization
and hospital readmission than those without filters. Other publications
in the medical literature reveal that many experts believe that IVC
filters are used too often.

In general, IVC filters are designed to be removed when they are no
longer needed. Removal is important because the filters themselves can
eventually cause DVT. Complications such as filter migration are also
possible.

In agreement with previous research on removal rates, the study found
that filters were removed in only a small percentage of patients.
Removal occurred in six percent of patients who received filters because
of a history of DVT or PE, and 16 percent of those who had filters to
prevent DVT or PE following surgery.

“Given that IVC filters were associated with greater rather than
diminished use of anticoagulants, our research suggests that IVC filters
may be overused,” said Mitchel Seleznick, MD, MPH, lead author of the
study and medical director, CarePlus, a Humana affiliate. “In addition,
the low rates of filter removal indicate that patients may be at
unnecessary risk of filter-induced DVT.”

“These real-world findings confirm what previous research has reported
for patients in academic medical centers,” said Laura Happe, PharmD,
MPH, director of research and publications at Humana. “This study, which
joins a growing body of research, underscores the need for closer
compliance with clinical practice guidelines for IVC filters.”

In the United States, one
or two of every 1,000 individuals develops either DVT or PE each
year, and approximately one third of these cases will experience another
DVT or PE within 10 years.

The study evaluated a managed care population with Humana health care
coverage from 2013 to 2014. This included 435 recipients of prophylactic
IVC filters, 4,376 recipients of therapeutic IVC filters, and two
control groups, each matched to filter recipients.

In addition to Dr. Seleznick, co-authors of the study include Jamieson
Vaccaro, MA, research scientist, and Karen Worley, PhD, pharmacy
research manager, both of Comprehensive Health Insights, which is a
research arm of Humana.

About Humana

Humana Inc. is committed to helping our millions of medical and
specialty members achieve their best health. Our successful history in
care delivery and health plan administration is helping us create a new
kind of integrated care with the power to improve health and well-being
and lower costs. Our efforts are leading to a better quality of life for
people with Medicare, families, individuals, military service personnel,
and communities at large.

To accomplish that, we support physicians and other health care
professionals as they work to deliver the right care in the right place
for their patients, our members. Our range of clinical capabilities,
resources and tools – such as in-home care, behavioral health, pharmacy
services, data analytics and wellness solutions – combine to produce a
simplified experience that makes health care easier to navigate and more
effective.

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